Microsurgical Replantation of a Small Segment of Thumb Volar Skin

Abstract

This report presents a case of microsurgical replantation of a volar skin segment of the thumb. In a 24-year-old patient, a heavy object falling over the dominant thumb resulted in a crush-avulsion injury of a pure skin segment measuring 4 x 2 cm. Examination revealed that the distal fingertip as well as the bone-tendon structures remained intact. Exploration demonstrated that both neurovascular bundles were included in the avulsed skin segment. Microsurgical replantation was achieved successfully, repairing the radial digital artery at both ends with vein grafts as well as anastomosing a palmar vein. Both digital nerves were coapted proximally and distally. An excellent functional and cosmetic result was accomplished with a good sensory recovery. The authors conclude that microsurgical replantation should be attempted in cases of more proximal pure skin avulsions, even if the injury spares distal fingertip tissue or bone-tendon units. In such cases, replantation is superior to any other method of reconstruction. Liberal use of vein grafts is crucial to achieve success.

Salvage of the skin envelope in complex incomplete avulsion injury of thumb with venous arterializaiton: A case report

“…4 However, the proper artery for the avulsed tissue is usually hard to identify and is often absent or traumatized. Salvaging the avulsed skin envelope using AV shunting is based on digit replantation 5,6,11 and using the arterialized venous flap. 7,10 The arterialized venous system can provide a high inflow blood pressure and nutrient supply via capillary network.…”

Replantation of amputated finger composite tissues with microvascular anastomosis

“…[5][6][7][8][9][10][11] However, if the vascular vessels in the detached tissues of finger are suitable for anastomosis, replantation of these composite tissues would achieve better results than any kind of reconstructive procedure. 12 In this article, our experience with microsurgical replantation of 24 amputated finger composite tissues in 21 patients is presented.…”